South Region Urgent and Emergency Care Summit Solution Building: Leading Transformation Reading, 21st March 2017

Debbie Sorkin

National Director of Systems Leadership, The Leadership Centre

Debbie.Sorkin@leadershipcentre.org.uk

@DebbieSorkin2

Starting point. You will be leading transformation in complex situations. So: a) you might not actually be in charge b) ‘no plan survives contact with the enemy’ (not even an STP) c) the transformation might be low-tech/mundane

A reminder: what complex issues can feel like…

•…they’re new, recalcitrant or intransigent – you don’t know what to do, you put up with poor systems because you’re used to them or the issues have been around for ever and seem impossible to fix •…they can’t be solved in isolation •…they sit outside single hierarchy and across systems •…you don’t know where they start or end – sometimes you can’t even agree on what the issue is •…there are no right or wrong solutions; rather you need to aim for progress and better developments •…you work with constant uncertainty and ambiguity

One – tried and tested - way to work with complexity: Systems Leadership. How you lead together in complex situations

“Leaders are struggling to innovate, integrate, manage demand and find new solutions.” “Leaders are wrestling with ‘wicked issues’ that shape-shift and defy resolution, and which cannot be resolved by single agencies acting alone.” “We are…applying systems thinking to the practical reality of trying to achieve complex change.” Sue Goss, ‘A View from the Bridge’, OPM May 2015

The idea behind Systems Leadership is to ask some different questions and work with some different people, to get to a shared ambition on which you can co-operate to get real change

Systems Leadership: The collaborative leadership of a network of people in different places and at different levels in the system, creating a shared endeavour and co-operating to make a significant change.

Questions to start with to get to the shared endeavour: What do we want services to be like for people in our place? Who else needs to be in the room?

What not to start with: Structures/organisations/hierarchies Governance Money

The basics: Relationships, influence, trust: “Systems move at the speed of trust” Partial, clumsy and emergent solutions Going slow to go fast

There’s lots of learning about Systems Leadership, and about what works and what doesn’t, from national and regional programmes: pilfer these relentlessly (see references on last slide)

Examples of what works: Systems Leadership rather than Systems Leaders (clue: there’s no such thing as a Systems Leader)

“The best systems leaders are not described in terms of charismatic heroes or divas, but as thoughtful, calm personalities who are as confident working in the background, supporting and enabling others, as they are in the limelight, leading from the front’. From ‘Exceptional Leadership for Exceptional Times’, Virtual Staff College, 2013

Learning from research: six dimensions of Systems Leadership around behaviours and values that can help you in leading transformation

• Ways of feeling - about strong, personal values • Ways of perceiving - about listening, observing and

understanding • Ways of thinking – about intellectual rigour in analysis

and synthesis • Ways of relating – the conditions that enable and

support others

• Ways of doing - behaving in ways that lead to change – includes narrative and reframing skills

• Ways of being – personal qualities that support distributed leadership

Dimension 1: Ways of feeling A relentless stress on personal core values

• Came through in literature review, case studies and first hand accounts

• Systems leaders are described (and describe themselves) as using their values as the foundation of what they do

• Can manifest itself as people being driven by over-arching interest in needs of service users and quality of public services – eyes on the prize

• Also comes out as personal commitment and emotional investment in the work

• Links to necessary energy and resilience to stick with something when times get tough and there are setbacks

Wirral: tackling food poverty Public Health team started “Better Food Wirral” food movement, shifting narrative and ceding leadership, asking question: how can we change the local food systems for a happier, fairer and healthier Wirral? Included community cafés, HAs, schools, other VCS.

Barnet Troubled Families Over the course of three years the project went through three different incarnations, each time requiring changes in scope and scale: “If I didn’t believe in the work I don’t think anyone would believe in me (and) I wouldn’t have had the energy required for it…!”

Dimension 2: Ways of perceiving What is observed and heard (NB this is also about noticing the frames and what isn’t there)

• Make time for an observing eye

• Get off the dancefloor and onto the balcony

• Advantage: you get a better view of what’s happening in the round if you have a wider perspective

• Links to idea of connecting the system to itself

• BUT note that there may be other dancefloors: so visualise what might be out of view

• What is heard, and how it is heard/perceived, is key

• This includes hearing challenge as positive: ‘cherish your outliers’ and expose the problems

• Involves thinking about frames/emotions people use

Cheshire West and Chester: reducing social isolation Getting away from council-based solutions: identified different cohorts of people suffering social isolation; developed community-led approaches including emergency services, schools, housing associations, faith groups.

Bradford Total Place programme Leaders described it as a ‘life-changing experience’ with more effective solutions arising from being developed from perspective of people using services.

Frames: culture in shorthand ‘A set of internalised concepts and values that allow us to accord meaning to unfolding events and new information’

• Mental shortcuts to images and associations

• Often based in metaphor: affect the way we think/make

assumptions

• Often shielding unspoken emotions/deeply held values: ‘This is how we are/do things’: this is how they are

• They prime for associations – prisms and prisons

• They trump facts – and rationality - every time

• And because they’re continuously reinforced and follow

familiar grooves, they can be hard to shift

• But once a new frame becomes established, and it’s become widely accepted, the previously unthinkable becomes ‘common sense’

• Reframing gives you a way to get your point across in ways that change thinking

“I aligned with Robin Cook in opposing the [Iraq] war. Within 12 months you couldn’t meet a member of the public who had ever known anybody who was in favour of it.” Ken Clarke, interview in The Times, Feb 2017

Why Framing Matters

“When the facts met the myths they were as useless as bullets bouncing off the bodies of aliens in an HG Wells novel.” Reader’s comment in the Financial Times, 24/6/2016

NB: The messenger often is the message

“It was a craven and defeated speech of a bitter man who was heavily defeated by the electorate for his own failings in Europe in 1992.” Jacob Rees-Mogg MP, commenting on the speech

Dimension 3: Ways of thinking Cognition, analysis and synthesis

• It’s not just about ‘feeling your way’/EQ

• Intensely cerebral in practice: rigorous and demanding intellectual work

• You need analysis and synthesis to underpin enabling ‘sense-making’ skills

• Also linked to public narrative: ability to deconstruct complexity and enable others to act

• Open-mindedness and ‘constant curiosity’

• Willingness to learn

• ‘Bricolage’ – creative amalgamation of multiple sources and resources

Solihull: services for older people + MH services Clinical Commissioning Group heads and Director of Adult Social Care used power mapping, narrative and framing to get progress on integration re: dementia and MH services.

Notts MASH Partners across the system used ‘systems maps’ and realistic examples to ‘think out loud’ in order to learn about others’ perspectives and make sense of what was actually happening. Key was to be curious about differences and problems, rather than trying to impose consensus.

Dimension 4: Ways of relating Empathy, integrity and authenticity

• Relationships, and the ability to build and maintain them = the key attribute of good systems leaders

• Supports participatory nature of systems leadership

• Needed to be able to exercise influence – when you don’t have power/are not in charge

• NB NOT THE SAME AS NETWORKING

• Based on mutual respect, empathy and the long haul

• And based on as much transparency/integrity as you can muster: you can be too tactical.

• About being clear about the bottom line – so goes back to shared ambition, using values and building TRUST

•

Calderdale: increasing physical activity Health & Wellbeing Board worked closely with LA, schools and the community: programme included training girls in schools in research methods so they could find out what would help/hinder increasing sports participation – aim to build social movement.

Adur and Worthing Local Vision: new ways of relating re: mental health/homelessness Fundamentally changed outcomes based on creating new capacity re: MH hospital discharge – mobilised frontline staff and clinicians to make joint visits which led to immediate improvements in discharges.

Dimension 5: Ways of doing Enabling, influencing and supporting others

• About behaviours and actions that enable and influence others to make change

• Stimulating, facilitating and enabling actions that are taken by others across the wider system

• Thinking laterally and eclectically to use what exists to

create something new – re-purposing

• About public narrative: ability to make sense of complexity and interpret it for others without being overly reductive or simplistic

• Leading onto constructing a coherent narrative that binds together around a core purpose

• And flexing/revisiting that narrative around different concerns of different parts of the system

Wakefield Pioneer: connecting services 3 Connecting Care Hubs now set up, with people working together from single sites: teams include community matron, staff nurses, OTs, physios, therapy support staff, pharmacists, VCS and social services. Outcomes include extended and faster access, quicker referrals and more seamless care.

Leeds Pioneer: joining up the workforce Developed database of all health and social care staff in city – geo-mapping where people live and work, and forming integrated neighbourhood teams across the city.

Dimension 6: Ways of being Personal qualities – a unifying dimension

• About attributes

• You are what you model

• Energy, drive and determination

• Ability to accept there will be setbacks

• Courage to keep going in face of anxiety/uncertainty

• Confidence and willingness to take some risks and do things differently

• Taking the long view

• A little humility goes a long way

“It means not losing confidence in your colleagues or in yourself when things don’t go the way you’d hoped or thought, or people have not delivered…going back around the loop again in terms of saying ‘that hasn’t worked, why hasn’t it worked, what could we do differently’?” DCS interviewed for Systems Leadership Research, 2013 North West London Integrated Care Partnership Individual leaders found they had to have the ‘courage to let things run’ in the interests of the greater whole, rather than intervening early – especially bold in the light of increasing scrutiny and risk aversion of NHS culture.

Summary: Systems Leadership behaviours to look for in yourself and develop in people when you’re looking to build solutions

•Willingness to align around a shared purpose or ambition •Able to build engagement/relationships and really listen: able to reframe/influence •Preference for outcomes over processes • Not being bound up with role and with a willingness to take risks • Able to work reasonably well with conflict and uncertainty • Having a strong commitment to a service in a particular place

Where to start in building solutions: practical first steps for you, your teams and the people you work with

• Be on the lookout for work avoidance: doing the wrong thing busily • Identify an issue where you can do real work: follow the energy, have honest

conversations and work towards a shared endeavour • Use your values, start from where you are, use what you have, start small: build

relationships and alliances with a coalition of the willing – and meet offline

• Create a holding environment – bring the right people together, especially real leaders who are making change happen (or who could do so): keep citizens at the centre

• Understand the scope for changing the system and choose your battles/interventions

• Only have a formal meeting if it’s useful: = if it changes something

• Expose the conflict and cherish your outliers

• Challenge norms – ‘why don’t we…’ and be a deliberate disruptor: explore new ways to do things

Worth pasting to the wall: Myron Rogers’ “ Working with Living Systems” Myron’s Maxims

Myron’s Maxims: o People own what they create o Real change takes place in real work o The people that do the work do the

change o Start anywhere but follow it

everywhere o Keep connecting the system to itself

o The process we use to get to the

future determines the future we get

Summary: What this might mean for you in leading transformation and building solutions

• Using Systems Leadership approaches can really help you in leading transformation

• See yourselves and your teams as systems leaders and enablers - part of a wider system

• Start with leadership behaviours, values and shared ambition - what do we want services to be like for people in a place

• Start from where you are, use what you have, start small

• Make connections and build relationships, especially with the real leaders who are making change happen (or who could do so): keep patients at the centre

• Build alliances and networks - a coalition of the willing – and meet offline

• If you’re trying to make change happen, recognise that it takes time and sometimes stuff gets in the way – wrong time/place/people

• Keep going: take the scenic route, allow for setbacks, look for progress rather than solutions: it really is possible to see change in your place

Thank you. Questions and discussion

Solution Building: Leading Transformation Table reflection and discussion

Some potential areas to think about:

Are Systems Leadership behaviours and approaches striking a chord with you? Why is this, do you think?

Where are you already using Systems Leadership? What are you learning? What’s surprising you?

Where else might you apply it?

Who else should know about it?

A practical framing and reframing exercise for you to carry out with your teams

• Work in teams of 3

• One person in the group: brief the others on your issue

• Assign an identity/‘perceptual position’ to your partners – e.g. someone from a health

system, or local government, or the private sector – doesn’t matter who they are as long as they’re important to you

• Describe how you see the other players, how they see you and the effect on your plans

• Partners listen for how the person is framing the issue and how you’re framing them – i.e. observe what’s going on

• Partners feed back on the frames they’ve heard and opportunities for reframing

• You all reflect on ways to frame things differently – what would it mean to reframe an

issue, e.g. around the commissioning outcomes you’re looking for?

Systems Leadership – more information

www.leadershipcentre.org.uk Debbie.sorkin@leadershipcentre.org.uk @DebbieSorkin2

Systems Leadership website: www.systemsleadership.org The Revolution will be Improvised I & II - http://tiny.cc/revolution and http://tinyurl.com/jhnllck NHS Leadership Academy – www.leadershipacademy.nhs.uk Developing People – Improving Care - http://tiny.cc/odzijy Systems Leadership/Virtual Staff College research - http://tinyurl.com/VSCSEC Pioneers One Year On report: http://tinyurl.com/olfozgx and Year 2 Annual Report: http://tiny.cc/89ns9x

Evaluations – http://tiny.cc/LV-InterimEval and via http://tiny.cc/ebtjby

Sue Goss, A View from the Bridge – http://tinyurl.com/p9c4rv2

Transformational change through system leadership - https://improvement.nhs.uk/resources/tcsl-programme/

Leadership for Change and Future Leaders – www.leadershipforchange.org.uk The Art of Change-Making – http://tiny.cc/TheArt

The Leadership Qualities Framework – http://tiny.cc/4vpt1x